Head and Neck Cancer Therapy De-Escalation: A “Salutary Lesson”

Hisham Mehanna PhD ARCS warns not to "de-escalate" therapy for head and neck cancer.

MUNICH—A “salutary lesson” was reported by researchers investigating therapy for oropharyngeal cancer at the 2018 annual congress of the European Society for Medical Oncology (ESMO). It came from results of the De-ESCALaTE HPVstudy that found patients with low-risk head and neck cancer who tested positive for human papilloma virus (HPV+) did better if they had been treated with standard platinum-based chemotherapy (added their radiotherapy) rather than the epidermal growth factor receptor (EGFR) inhibitor cetuximab.

“One of the big lessons is that you really need phase three trials—even when treatments are already approved—as in [the] case [of] head and neck cancer,” said Hisham Mehanna PhD BMed Sci FRCS, Chair of Head and Neck Surgery at the Institute for Head and Neck Studies Education in the University of Birmingham, UK. “You need phase three trials to compare new treatments to standards of care to really be able to take [them] into the clinic,” he told the Audio Journal of Oncology. “Clinical practice should not be changed without these phase three trials.”

Detriment from cetuximab

TheDe-ESCALaTE HPV study—reported at ESMO by Mehanna and his colleagues—found there had been “significant detriment from the use of cetuximab instead of cisplatin in terms of tumor control and no benefit in terms of reduced toxicity. They concluded that: “Cisplatin and radiotherapy remained the standard of care in this setting.”